摩洛哥耐药结核病患者的治疗结果：多中心前瞻性研究。
Treatment outcomes of drug resistant tuberculosis patients in Morocco: multi-centric prospective study.
机构信息
Equipe de Recherche de Pharmacoéconomie & Pharmacoépidémiologie. Laboratoire de Pharmacologie & Toxicologie, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco.
Service de Pneumologie, Hôpital My Youssef, Rabat, Morocco.
出版信息
BMC Infect Dis. 2019 Apr 11;19(1):316. doi: 10.1186/s12879-019-3931-5.
BACKGROUND
Drug resistant tuberculosis is a major public health problem in Morocco and worldwide. Treatment outcome of drug resistant tuberculosis is poor and requires a long period of treatment with many toxic and expensive antituberculosis drugs. The aim of this study is to evaluate treatment outcomes of drug resistant tuberculosis and to determine predictors of poor treatment outcomes in a large region of Morocco.
METHODS
It is a multi-centric observational cohort study conducted from January 01, 2014 to January 01, 2016. A questionnaire was established to collect data from clinical charts of patients with confirmed resistant TB. The study was carried out in all the 11 centers located in the Rabat-Salé-Kénitra region of Morocco where drug resistant tuberculosis is treated. Treatment outcomes were reported and the definitions and classifications of these outcomes were defined according to the WHO guidelines. Univariate and multivariate logistic regression were conducted to determine factors associated with poor drug resistant tuberculosis treatment outcomes in Morocco.
RESULTS
In our study, 101 patients were treated for drug resistant tuberculosis between January 01, 2014 and January 01, 2016. Patients' age ranged from 9.5 to70 years; 72patients (71.3%) were male and 80 patients (79.2%) were living in urban areas. Thirty two patients were smokers, 74 patients had multidrug-resistant tuberculosis, 25 patients had rifampicin resistance and 2 patients had isoniazid resistance. Treatment outcomes of tuberculosis patients were as follows: 45 patients were cured (44.5%), 9 completed treatment (8.9%), 5 patients died before completing the treatment, 35 patients were lost to follow up (34.6%) and 7 patients had treatment failure. In the multivariate analysis, being a smoker is an independent risk factor for poor treatment outcomes, (p-value = 0.015, OR = 4.355, IC [1.327-14.292]).
CONCLUSION
Treatment success outcomes occurred in more than half of the cases, which is lower than the World Health Organization target of at least a 75% success rate. A significant number of patients abandoned their treatment before its completion. These dropouts are a serious public health hazard that needs to be addressed urgently.
背景
耐多药结核病是摩洛哥乃至全球的一个主要公共卫生问题。耐多药结核病的治疗效果不佳，需要长期使用多种有毒且昂贵的抗结核药物进行治疗。本研究的目的是评估摩洛哥一个大区耐多药结核病的治疗结果，并确定不良治疗结局的预测因素。
方法
这是一项多中心观察性队列研究，于 2014 年 1 月 1 日至 2016 年 1 月 1 日进行。通过临床图表收集确诊耐多药结核患者的数据，建立了一份问卷。该研究在摩洛哥拉巴特-塞勒-凯尼特拉大区的 11 个中心进行，这些中心都可治疗耐多药结核病。报告了治疗结果，并根据世界卫生组织指南定义和分类这些结果。进行了单变量和多变量逻辑回归分析，以确定与摩洛哥耐多药结核病不良治疗结果相关的因素。
结果
在我们的研究中，2014 年 1 月 1 日至 2016 年 1 月 1 日期间，有 101 名患者接受了耐多药结核病治疗。患者年龄为 9.5 至 70 岁；72 名患者（71.3%）为男性，80 名患者（79.2%）居住在城市地区。32 名患者为吸烟者，74 名患者患有耐多药结核病，25 名患者耐利福平，2 名患者耐异烟肼。结核病患者的治疗结果如下：45 名患者治愈（44.5%），9 名完成治疗（8.9%），5 名患者在完成治疗前死亡，35 名患者失访（34.6%），7 名患者治疗失败。多变量分析显示，吸烟是治疗结果不良的独立危险因素（p 值=0.015，OR=4.355，95%CI[1.327-14.292]）。
结论
超过一半的病例治疗成功，低于世界卫生组织至少 75%成功率的目标。相当多的患者在完成治疗前放弃了治疗。这些脱落是一个严重的公共卫生危害，需要紧急解决。
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